House bills could end guaranteed AIDS funding

Published 4:00 am, Monday, July 17, 1995

AIDS research and housing programs, which have enjoyed special status in the federal budget, may soon have to duke it out with other interest groups for a slice of the same shrinking budget pie.

Two spending bills approved last week in House subcommittees do more than simply set spending levels: They reject the notion that AIDS deserves its own earmarked funds.

Alarmed, AIDS advocates say these would leave them with no guaranteed budget. The decisions, they say, could reverse recent progress against the disease.

Congress is acting "with reckless disregard for the pace of scientific progress against AIDS and the best interests of people living with HIV / AIDS now and in the future," angrily asserts Mathilde Krim, co-founder and chairman of the board of the American Foundation for AIDS Research.

One bill, endorsed by a House Appropriations subcommittee, would designate no money specifically for AIDS research, a reversal from the last two years. And the National Institutes of Health's Office of AIDS Research, which since 1993 has coordinated federal AIDS research, wouldn't play such a role. Instead, the subcommittee voted to send money to the 24 individual institutes of NIH - among them cancer, heart disease and mental illness - with spending decisions left to each institute director.

The other bill - approved by the subcommittee on Veterans' Affairs, Housing and Urban Development and Independent Agencies - would produce major changes in the structure of HUD. The nation's only program for AIDS housing would be lumped with two other special-needs groups: the elderly and the disabled. If the AIDS program gets the short end of the funding, advocates fear shelters could be shut and people could be thrown onto the street.

A long, ugly battle?&lt;

The subcommittee bills set the stage for what could be an ugly fight for money between AIDS advocates and other groups representing the elderly and those suffering from a variety of diseases and disabilities. That would shatter the groups' unity in fighting for increased research budgets on all fronts.

Both bills are expected to go to the Appropriations Committee this week, then to the full House, through the Senate and on to the White House. They place the burden on AIDS researchers and activists to explain why they, and not others, deserve budget set-asides.

Legislators say resources are scarce and must be allocated fairly to a myriad of research and housing needs.

Republicans such as Rep. John Porter, Ill., argue, in the words of his press secretary, Dave Kohn, that "when specific earmarking for a disease is put into a bill, it amounts to a political decision to fence off funds - whether we're talking about breast cancer, prostate cancer, AIDS or whatever."

"It's dangerous because whatever disease has the most effective lobbyists, gets the most resources," Kohn said.

The AIDS housing program, called Housing Opportunities for People With AIDS, has relied on set-aside monies. Under the current proposal, it would compete with housing for the elderly and the disabled for its share of a $1 billion appropriation, down from $1.86 billion in 1995 for all three programs.

The only federal housing program that specifically helps people with AIDS, it sent $12.4 million to San Francisco and $1.5 million to Oakland this year. Next year, activists expect far less.

"They want us to fight amongst ourselves," said Aimee Berenson, legislative council of the Washington, D.C.-based lobbying group AIDS Action Council. "And because these two other programs have prior (spending) obligations and commitments, (the AIDS housing program) probably won't get anything."

GOP legislators respond that they're protecting the AIDS program by placing it in a three-program fund rather than throwing it out in the cold to compete with the 150 other HUD grants.

An end to cooperation?&lt;

In the research arena, disease groups have traditionally worked under umbrella organizations, such as the Coalition for Health Funding, to expand total medical research money.

But now that the nation's research budget will barely keep ahead of inflation - a proposed 5.6 percent increase in National Institutes of Health spending for fiscal year 1996 - a boost in one NIH program must come at the expense of another.

Advocates for other disease programs note that the federal government spends only a few cents for research per dollar of patient care for cancer, heart disease, diabetes, stroke, Alzheimer's disease and emphysema while spending more than $2 on AIDS research for every dollar on AIDS patient care.

AIDS advocates say that HIV deserves special attention because it is a new, spreading and still-incurable infection that kills people in the prime of their lives.

They say there is a desperate need for coordination in AIDS research. Because HIV affects every organ of the body, research cannot be concentrated in one institute. It is unlike breast cancer, they note, which is studied almost exclusively at the National Cancer Institute.

For the past several years, the NIH's Office of AIDS Research has managed and organized the government's $1.4 billion AIDS research program. This strengthened the position, increased the visibility and improved the organization of AIDS research at NIH. The office even had a $10 million annual discretionary fund that it was free to use on an emergency basis for new research areas or trouble shooting.

But leaders of the Republican-led budget proposals argue that NIH did not need another layer of bureaucracy - and that research opportunities do not come in narrowly defined, disease-identified packages. The Office of AIDS Research will still play an advisory role, they add.

AIDS advocates worry that, despite such reassurances, the ulterior motive of conservative lawmakers is to reduce the federal commitment to AIDS.